Many surgical procedures involve the attachment of soft tissue to bone. For example, to repair a torn rotator cuff, a surgeon may have to reattach a rotator cuff tendon to the humerus bone. A surgeon can stitch the tendon to the humerus by passing a suture through the tendon, anchoring the suture to the bone underneath, and securing the suture with a knot, fastener, or the like. Depending on the application, the suturing process may involve single-row, dual-row, or mattress stitching.
A number of approaches exist for suturing soft tissue to bone and particularly for the anchoring of a suture in bone. Some involve the use of suture anchors that are placed into holes drilled in the bone. A variety of suture anchors are available, including screw-type, toggle-type, barb-type, sprung tines, deployable or deformable arms, and knotless and/or expanding mechanisms. Other techniques involve passing a suture through a tunnel formed in the bone or manually pushing a suture into one hole formed in the bone and out of another, leaving two free ends of suture which can be secured above the soft tissue. More recent approaches involve the use of adhesives and/or reinforcing patches for the suture in conjunction with bone anchors or holes pre-drilled into the bone surface.
The need to pre-drill and/or substantially stress the bone surface is a significant drawback to many of these techniques. They also often result in considerable trauma to the overlying soft tissue, particularly where the footprint or exposed area of the bone must be relatively large. They can be difficult or impossible to perform percutaneously. In addition, the use of bone anchors leaves a foreign object in the body, which can be the cause of later complications.
There is a need in this art for novel devices and methods for attaching a suture to bone that exhibit high pull-out resistance, can be performed with low trauma to bone and overlying tissue, and that can be used percutaneously as well as arthroscopically and in open surgery.